Provider Demographics
NPI:1609830538
Name:HEPWORTH, WILLIAM BRADFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADFORD
Last Name:HEPWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SOUTH 100 WEST, #1049
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8639
Mailing Address - Country:US
Mailing Address - Phone:801-692-1304
Mailing Address - Fax:
Practice Address - Street 1:9771 N OXFORD CIR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8639
Practice Address - Country:US
Practice Address - Phone:801-692-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT288828-1205208D00000X
WAGA10000286207L00000X
WADE000081471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
91-2039850OtherEIN
91-2039850OtherEIN